North Carolina (NC) has created a nationally recognized program of primary care redesign and ongoing improvement that serves as a model of aligned state-level multi-sector practice support. Over the past several years we have pulled together a series of highly interconnected initiatives and built them into the infrastructure of existing statewide institutions. The multi-sector program continues to grow a large and coordinated series of supports for primary care practices, hospitals, and communities as we continue to transform health care in our state. The NC program of practice support is built upon a broad-based and sustained infrastructure that is allowing us to spread to all practices in the state. Two statewide programs, Community Care of North Carolina (CCNC) and the North Carolina Area Health Education Centers (NCAHEC), engage primary care practices in enduring regional improvement networks supported by practice facilitators and 'mini-collaboratives'. This structure also enables practices to access shared community resources to advance care for their patients. The North Carolina Healthcare Quality Alliance (NCHQA), a non-profit organization representing all major healthcare stakeholders in the state, serves as a coordinator and supporter for quality improvement programs. For the IMPaCT project, we will enhance our current efforts by conducting a regional leadership development program that will enhance the effectiveness of the regional medical and quality improvement leaders. We will also enhance our current patient-centered medical home change package to included focused attention on the role of primary care in transitions between care settings. In addition to several ongoing evaluations in the state, we will evaluate the rate of improvement in performance, utilization, and cost of care by duration in CCNC and participation in NCAHEC improvement networks. Because we have several different methods of performance assessment (multiple payer claims and practice reported performance), we will be able to compare results across payer and methodology. Lastly, a major aspect of this proposal is to disseminate the NC primary care practice support model so that other states can take advantage of our experience and lessons learned. We will work with the National Academy for State Health Policy to disseminate tools and experiences broadly through issue briefs, detailed descriptions of the NC programs, and national webinars and conferences. We will also work intensively with 3 states to help them implement their own multi-sector primary care support efforts.